Persistent hemorrhoids require a physician’s attention

You can safely put any number of bad things behind you and just move on, but Cleveland Clinic Indian River Hospital gastroenterologist Dr. Yakov Gitin warns that hemorrhoids may not be one of those things.

“Just this year alone,” says Gitin, who served both his internship and residency at the Harvard-affiliated Beth Israel Deaconess Medical Center in Massachusetts, “there were at least three patients I can think of who thought that they just had hemorrhoids and two of them ended up having anal cancer and one had rectal cancer.”

Gitin quickly adds, “It’s OK to try and treat your hemorrhoids for a couple of weeks and see what happens. If they resolve, fine, but if symptoms persist and they don’t go away, then it’s time for you to see a physician.”

Do you need a specialist like Gitin for hemorrhoids? Maybe. Maybe not.

“It’s OK,” Gitin explains, “to start with your primary care physician because the first treatment is conservative. We’re trying to adjust the diet, make sure you are eating enough fiber, and making sure that constipation and diarrhea are addressed. And a primary care physician is more than capable of doing all of those things.”

So, what exactly are hemorrhoids?

The Mayo Clinic says “hemorrhoids (also called piles) are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

“Nearly three out of four adults will have hemorrhoids from time to time,” according to the Rochester, Minn., institution, and they become increasingly common as we age. Symptoms can include itching or irritation in your anal region with pain or discomfort, swelling around your anus and bleeding.

And, as often as not, we – ourselves – are at least partially to blame.

Spending too much time on the toilet, according to Gitin, straining to induce a bowel movement, can exacerbate the problem.

Or, as Gitin puts it, “stop hiding in the restroom from your family. Don’t bring your phone or your iPad into the restroom. Allow a certain amount of time to be on the toilet. If nothing happens within the next five to 10 minutes, you need to get up, walk away and wait for the urge. When the urge happens, you should go to the bathroom and have your bowel movement, but don’t just sit there waiting for things to happen.

“If you’re constipated,” Gitin continues, “take a gentle laxative. If you have diarrhea, which also is a risk factor for hemorrhoids just like constipation, then the diarrhea needs to be controlled with medications. Again, you should talk to your physician about this issue.”

Increasing dietary fiber is a recurring theme in both the medical literature and in Gitin’s observations.

“So, what happens with the diet,” Gitin explains, “is if you increase the amount of fiber in your diet, then your stool becomes softer. When your stool becomes softer it takes much less effort and strain to push the stool out. And so over the course of – usually a week or two – hemorrhoids begin to shrink. Not always, but 50 to 60 percent of the time, they do. So, if that happens, then there’s nothing else that needs to be done.”

But, Gitin cautions, the problem with waiting too long to address the issue is that many people think they’re experiencing anal bleeding or pain because of hemorrhoids, but it’s not always the case. It could be other, more serious problems. Including cancer.

Only your doctor can diagnose the more serious problems that you might think are “only” hemorrhoids.

“The first step,” says Gitin, “is always conservative therapy with diet and fiber supplementation, lifestyle modifications, et cetera.”

If that fails, the next step is to try minimally invasive treatments, which would likely include rubber band ligation, the most commonly used hemorrhoid treatment in the United States, during which a small elastic band is placed around the base of a hemorrhoid causing it to shrink. However, it can take two to four procedures, done six to eight weeks apart, to eliminate the hemorrhoid using his technique.

Other treatments include “thermal therapies” such as infrared coagulation and bipolar coagulation.

If these fail, the third step would likely be to send the patient for a surgical consultation.

“I think the most important point in this conversation should be ‘do not assume that you have hemorrhoids’ just because you have rectal pain or bleeding,” Gitin explains. “You have to make sure that nothing else is going on.”

Dr. Yakov Gitin is a gastroenterologist with Cleveland Clinic Indian River Hospital. He has a five-star rating on the website. His office is at 3450 11th Court, Suite 206. The phone number is 772-299-3511.

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